Bulimia

[nkresho]

So, has anyone had any luck in self treating bulimia nervosa with GLPs? It seems like a perfect pairing in many ways. Quiet the cause of the binge, thus eliminating the need to purge.

I read a metanalysis on NIH and found it pretty intriguing.

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Not a lot of other info or any studies out there though...

I've struggled with binge eating my whole life.

I remember as a small child, the christmas mornings, easter mornings (those huge baskets with chocolates and other candies), day after a huge halloween candy windfall, where i'd down massive quantities of candy and sweets. It was permitted in my household as it's a "special occasion".

I had instances as a child where i remember eating 6 or more donuts, back to back, and sort of trying to hide it from others in the household by eating super fast so nobody would see me. In college i remember eating a whole hamburger helper box (with the added 1# of ground beef) in a sitting and not really feeling fully satiated.

More recently, i have been on a keto journey, losing a lot of fat by strictly restricting carb intake. Eventually the cravings for sweets and carbs were less as it had been a long time since i had them.

Then, i discovered some new vices. There's a company called choczero that makes "keto-friendly" sweets. I was self-rationalizing that i could totally eat these and stay within my boundaries. At first i'd eat a couple and be fine. Then it got to a point where i'd eat the whole box in a sitting. Then sit there feeling helpless and completely out of control. Fully remorseful of what i had just done. Those of you who have dealt with bulimia know what tends to follow that, and it always did for me. Getting progressively worse as time went on.

So yeah, started reta yesterday and started reintroducing carbs under the idea that i'd be watching my macros closely. I fully intend to but am very hopeful that the binging behavior can be curbed or eliminated by the introduction of the reta.

Anybody else seeing improvements in binging tendencies using reta or other GLPs?

 

[woundcarping]

Binging and bulimia seem related but separate ideas. I would binge, but I never purged.

GLP are an enormous help to me for portion control.

 

[nkresho]

Right, so you can have a binge eating disorder without being bulimic. But can't really be bulimic without the binge.

Compulsive, uncontrollable eating is just the first half of bulimia. As i imagine, same with most of us in here, we feel helpless and it sort of takes over. We eat more than we know we should (more than our logical brain says is right). Sometimes it's going from a portion of something to the entire container. Other times it's just a food we know we should not eat to begin with, but we want it so bad we give in and eat it.

The added issue with bulimia is that afterwards we feel incredibly guilty for eating that thing, and we feel compelled to purge and "un-do" the wrong we just did (eating something we know we should not be eating). It's the "back" button or the "undo" button.

Then, psychologically, we can rationalize the whole thing before it happens. I know i can't stop myself from eating that treat, but i also know that when i am done i can make it right (and ultimately preserve my physique) by purging it out of my system.

All made more confusing since we're human and this does not mean we binge and purge every meal or purge every time we eat. Only certain situations give that guilty feeling and subsequent compulsion to purge.

Body image is a major part of it too. Looking in the mirror and not seeing what you want to see is a motivator to be more aggressive. Distortions in body image exacerbate it further.

 

[Elocin]

The thing with eating disorders, is they stick with you for life. You can go years without the binge/purge cycle, and very easily fall back in. Was diagnosed at 14. I’m now 38.

For me personally, I have found Tirz has been helpful. However, I take Vyvanse for ADHD, which is also prescribed for BED. I have not had any b/p episodes since starting Tirz.

GLP-1s are currently being researched on their effectiveness in regard to treating addictions. So it makes sense to me that they would help in this aspect.

 

[lessthanhalf]

It might depend a bit on your weight, using GLP's might not be so ideal if underweight.

I definitely had food addiction/binge eating disorder not that I ever sought a formal diagnosis or specific treatment. But especially after weight loss, I found that eating even small amounts of rich/high calorie/highly rewarding/high glycaemic index foods triggered extreme more or less uncontrollable hunger a hour or 2 later. My theory is something to do with sudden peaks in blood glucose followed by dips and some weird brain chemistry causing extreme hunger. This has caused me to regain weight as it is very hard to stop once it starts.

I made up a diet, not keto, but as low glycaemic index as possible, very high protein 40-50% of calories, very low fat to get the calories low, and low calorific density , ideally 1 kcal/gram of food so you can at reasonable quantities of food to help reduce hunger. With total avoidance of any highly rewarding high calorie foods. And lost about 70kg from 145kg. Keeping the weight off was difficult, I was hungry most of the time. but stuck to avoiding high calorie foods totally and kept at that weight for a year. But avoiding high calorie foods did prevent episodes of extreme uncontrollable hunger.

After that started ozempic for a year, which helped a bit with hunger, but was nauseating, and then switched to tirzepatide, and added in reta and eventually cagri, and so far down to 64kg 3 1/2 years later. But have more or less stuck to total avoidance of foods that might trigger extreme hunger the entire time. Viewing them as just too addictive for me to be able to eat in reasonable amounts without losing control.

I agree that the research on GLP's and binge eating disorder looks promising, have not seen much about bulmia, but some of the issues are the same. I do not think it helps that the people who mostly deal with eating disorders are very focused on cognitive behavioural approaches to management , and not in favour of medical therapies, which I think blinds them to its possible usefullness ( I have nothing against cognitive behavioural therapies in general )

Assuming you are not underweight , it is not really that hard an experiment to try tirzepatide to see if it helps control hunger and binging. For me it reduces thinking about food, and reduces cravings for high calorie foods, makes me feel full with smaller amounts of food and makes maintaining the weight loss much easier. The extreme high calorie food restriction approach is definitely not for everyone, it seems to be working for me, but is restrictive and not ideal in terms of social eating, and does require a type of extreme discipline to stick to long term, even if its purpose is to prevent loss of control.

 

[NagChamp]

I really feel you. I had bullimia for many years (half of my life!) but eventually got outpatient treatment and 'recovered', in the sense that I was very rarely binging and purging anymore. BUT the food noise stayed and it has basically ruled my life since, even though most of the time I was able to navigate it and manage a healthy weight.

A key reason I'm using Tirz now is to manage the food noise as it was exhausting to have this voice in my head constantly chatting about food. I'm in week 4 of Tirz now and the food noise has subsided (although today it's a bit more than usual - possibly hormonal).

For me so far it's been a game changer and I have felt a freedom that I don't remember having before. I specifically chose Tirz over Reta for the food noise suppression, even though I am physyically active and Reta seems to be the GLP of choice for people who like to lift weights.

Good luck! I hope you can find a sense of freedom too!

 

[Elocin]

eventually got outpatient treatment and 'recovered', in the sense that I was very rarely binging and purging anymore. BUT the food noise stayed and it has basically ruled my life since

This. Right here. Perfectly explains my experience as well.

It might depend a bit on your weight, using GLP's might not be so ideal if underweight.

This is extremely important. While I think they can definitely be a helpful tool, it goes both ways. I think it’s important to be at a comfortable point in recovery, before introducing.

 

[tubby]

It's also worth considering that nearly every "disorder" out there has a mix of complex and varied causes and pathways that vary from person to person, in the end leading to the same result. I mean obviously you're not going to get bulimia without the binging behavior, but when it comes to the binging behavior itself, I suspect that's where pathways could vary a bit from person to person. Many report a dramatic reduction in "food noise" and addictive behaviors in general, which on paper sure sounds ideal for that sort of thing, but who knows.

I'd be very surprised if no bulimics found resolution through GLP use and I'd also be surprised if all bulimics found resolution through GLP use. So for you (an individual), I suspect the most productive answer is consider trying one to find out if it's personally beneficial to you.

One thing I might put a little more focus on is choosing one based on your weight. If you're currently skinny I probably wouldn't pick the one with the highest average weight loss results to dip my toes in with. Also be aware that when you see average numbers like 20% or 30% that's typically an average result at the highest dosing of a particular drug and there's no reason to think you'd need to escalate to a higher dose if it's just the psychological benefits that you're really after.

 

[JourneyToPerfection]

I can relate. For over 20 years I switched between binging and anorexia nervosa (total lack of gag reflex so purging never happened for me).
I would eat and eat and eat to the point where I’d occasionally be unintentionally sick, then eat some more. It was compulsive, I couldn’t control it once I started.
Turns out most of it was undiagnosed ADHD and I was dopamine seeking because my brain can’t regulate properly. Once I got on track with adhd meds, the urge to binge has basically gone. It’s been 5 years and I’ve maybe semi binged once while in a depressive state, but nothing on what I used to.
I’ve still had periods when my mental health has been trash and I’ve starved myself. I see a therapist & have a management plan in place with my best friend (who is also a psychologist) to help me when it starts again.
But the urge to binge is no longer.

 

[tubby]

But especially after weight loss, I found that eating even small amounts of rich/high calorie/highly rewarding/high glycaemic index foods triggered extreme more or less uncontrollable hunger a hour or 2 later. My theory is something to do with sudden peaks in blood glucose followed by dips and some weird brain chemistry causing extreme hunger. This has caused me to regain weight as it is very hard to stop once it starts.

That was always my theory too (and how a keto diet is typically pitched). One thing that surprised me along the way was when I tried playing with a high starch (with very low protein and very low fat) diet for a couple months I thought that for sure I'd be right back on that roller coaster. To my surprise, that didn't happen!

For that particular round it was just potatoes, which sounded amazing coming from low-carb. I think part of the reason for that is that the experiment was mostly just plain potatoes (well with some salt, some tomato product like salsa, and a tiny bit of olive oil to coat the potatoes) which is ultra-palatable for the first few bites, but by the time you're on your 4th or 5th one, somehow less palatable.

This told me that (at least for me) high-glycemic on its own may have been necessary, but wasn't sufficient to trigger the "blood sugar" roller coaster without some other component of the ultra-palatable nature of highly processed foods. On processed foods I would have experienced "hangry" after 3-4 hours and been craving a next meal. That just didn't happen with fairly plain potatoes.

I'm not selling that particular diet. I lost some weight on it and to my surprise I didn't feel awful, nor did I lose strength at the gym on it. And this was all pre-GLP, of course.

 

[nkresho]

Absolutely will vary a lot between people with the disorder.

For me, it didn't even really become a thing until i reached (or closely approached) my goal weight, pretty recently. It was more of a defense against losing all that i had worked for at that point.

I was happy with how i looked and not necessarily aggressively chasing a lower weight or a specific look in the mirror. I'd like to think it wasn't body dysmorphia, as i feel i have a pretty accurate idea of how i actually look. A lot of that has been confirmed by others as well, so not too skeptical of my perceptions in that area.

I'd see (or think about) the food my brain wanted to binge on. Typically sweets. Then logically decide that i will let myself eat that, but in turn i can't "keep it down". So i'd need to purge afterwards.

A very strange thing to try to explain... Just typing this out it seems strange to me.

 

[tubby]

Absolutely will vary a lot between people with the disorder.

For me, it didn't even really become a thing until i reached (or closely approached) my goal weight, pretty recently. It was more of a defense against losing all that i had worked for at that point.

I was happy with how i looked and not necessarily aggressively chasing a lower weight or a specific look in the mirror. I'd like to think it wasn't body dysmorphia, as i feel i have a pretty accurate idea of how i actually look. A lot of that has been confirmed by others as well, so not too skeptical of my perceptions in that area.

I'd see (or think about) the food my brain wanted to binge on. Typically sweets. Then logically decide that i will let myself eat that, but in turn i can't "keep it down". So i'd need to purge afterwards.

A very strange thing to try to explain... Just typing this out it seems strange to me.

I should add that you shouldn't necessarily assume a low-dose GLP will cause you to lose weight either. Depending on how frequently you engage in the bulimic behavior, that's obviously going to weigh into your overall weight equilibrium. It's entirely possible that without engaging in it, you would otherwise gain weight. Likely that gain would be offset by the effect of a GLP. So if a GLP enabled you to stop engaging in bulimic behavior, that also frees up whatever time you would have been engaging in it to consist of a normal meal.

So in your case there's an argument to be made that a GLP (depending on dose) could actually lead to weight gain or weight loss. Presumably it would be weight loss at a significant dosing and uncertain territory at low-dosing.

 

[nkresho]

Preventing or reducing the binge behavior is really what i hope to experience with the GLP. That would be pretty impactful in preventing the feelings of remorse or guilt that tend to follow the binge. The weight loss is way downstream IMHO.

It's the ability to stop eating something after a few bites or a reasonable "serving" as it compares to eating the whole container. My logical brain always knows what's right, exactly how much is the proper amount to eat (what fits in my macros), one cookie, one handful of it, one serving size, it's just that the compulsion takes over at times, driven by the overwhelming and intense urge to ravenously consume. I feel sort of like Gollum and that ring. My "precious sweets"! Then I turn my back to onlookers and hunch over the container so nobody sees me eat them all, barely chewing as quickly as possible. It's not really satisfying to me, it's just satisfying the internal "Gollum" that demands i feed it.

With experience, i feel like i learn that the "Gollum" will take over, so i plan for it, let him eat the whole container, knowing good and well that i will need to "address it" afterwards. Then, follow up with a purge and feel better, genuinely better, that i didn't actually eat the whole package. I just got the urge out of my system.

My apologies for anybody with an upturned eyebrow not getting my nerdy LOTR references.

 

[tubby]

Preventing or reducing the binge behavior is really what i hope to experience with the GLP. That would be pretty impactful in preventing the feelings of remorse or guilt that tend to follow the binge. The weight loss is way downstream IMHO.

If you do give GLPs a try, please be sure to update us in this thread on what the experience is like for you, as it's always fun to hear if things go the way you expect them to or if there are unexpected surprises and I suspect your data point might be more interesting to read, as it sounds like you've spent a lot of time thinking about and trying to unpack the nature of what you're dealing with.

 

[dancs]

Hey, so even though I "liked" all the posts here, I didn't read them. I only read the OP's message. 🤣

So, I apologize if what I say here, overlaps with the others.

I wrote up a whole essay, but decided to just take it all out dammit..

Anyways, taking reta AND tirz will help you tremendously, unless you're not overweight.

This is what I would recommend you research;

Tirzepatide
Retatrutide
Mazdutide
Survodutide
Cagrilintide
Eloralintide
Tesofensine

And these peps help support;

5-Amino 1mq (oral form, preferably.)
MOTS-c (must take SS-31 first for 4 weeks if your body condition was shit lately)
AOD-9604 (1 semi major study found results to be minimal BUT that study missed out a few things that would make it less credible. Many anecdotal reports state AOD makes a difference.)

 

[Moonshine72]

So, has anyone had any luck in self treating bulimia nervosa with GLPs? It seems like a perfect pairing in many ways. Quiet the cause of the binge, thus eliminating the need to purge.

I read a metanalysis on NIH and found it pretty intriguing.

Checking your browser - reCAPTCHA

Not a lot of other info or any studies out there though...

I've struggled with binge eating my whole life.

I remember as a small child, the christmas mornings, easter mornings (those huge baskets with chocolates and other candies), day after a huge halloween candy windfall, where i'd down massive quantities of candy and sweets. It was permitted in my household as it's a "special occasion".

I had instances as a child where i remember eating 6 or more donuts, back to back, and sort of trying to hide it from others in the household by eating super fast so nobody would see me. In college i remember eating a whole hamburger helper box (with the added 1# of ground beef) in a sitting and not really feeling fully satiated.

More recently, i have been on a keto journey, losing a lot of fat by strictly restricting carb intake. Eventually the cravings for sweets and carbs were less as it had been a long time since i had them.

Then, i discovered some new vices. There's a company called choczero that makes "keto-friendly" sweets. I was self-rationalizing that i could totally eat these and stay within my boundaries. At first i'd eat a couple and be fine. Then it got to a point where i'd eat the whole box in a sitting. Then sit there feeling helpless and completely out of control. Fully remorseful of what i had just done. Those of you who have dealt with bulimia know what tends to follow that, and it always did for me. Getting progressively worse as time went on.

So yeah, started reta yesterday and started reintroducing carbs under the idea that i'd be watching my macros closely. I fully intend to but am very hopeful that the binging behavior can be curbed or eliminated by the introduction of the reta.

Anybody else seeing improvements in binging tendencies using reta or other GLPs?

I hear you. Once winter kicks in for me, I hibernate and load up on carbs and some junk food. I usually lose about 80% of what I gained in the winter through the warmer months. My goal is to start skiing again so I can keep myself out of that seasonal depression cycle.

 

[Don]

Honestly, I don’t think a strict keto diet is the best approach for people who are trying to build a healthier relationship with food long term. In my opinion, cutting carbs too hard can actually make cravings for sugary foods even stronger, because those foods become “forbidden” and harder to moderate.

If you eat a balanced diet that includes carbs, it’s usually easier to make healthier versions of cravings without feeling completely restricted. For example, if you see desserts online or crave something sweet, you can make better alternatives with ingredients like bananas, cocoa powder, eggs, protein powder, or milk. With keto, your options are much more limited, and people often end up relying on “keto sweets” that can still trigger binge behavior.

In my own diet right now, I time most of my carbs around workouts and use them more as fuel. Even while staying lean, I can eat something like sugary cereal before training because I know I’ll use that energy during a heavy workout. After training, though, I stick to better carb sources like rice or potatoes.

I’m not saying carbs solve binge eating by themselves, but I do think extreme restriction can make food obsession worse for some people. A more flexible and sustainable approach might help more in the long run. I'm someone who struggles with big portions and preferably sweets like Ice Cream, Cakes, Chocolate, bakery etc. too, keto wasn't for me in my experience and the ones from people I "coached" around me

 

[tubby]

Honestly, I don’t think a strict keto diet is the best approach for people who are trying to build a healthier relationship with food long term. In my opinion, cutting carbs too hard can actually make cravings for sugary foods even stronger, because those foods become “forbidden” and harder to moderate.

That can cut both ways. Some people do well with a "baseline" level of "bad" foods and indulge at an acceptable level. Other people find that once they touch the bad thing (whether a food or alcohol or some other substance) they can't stop and binge on it. Varies quite a bit from person to person.

 

[Don]

That can cut both ways. Some people do well with a "baseline" level of "bad" foods and indulge at an acceptable level. Other people find that once they touch the bad thing (whether a food or alcohol or some other substance) they can't stop and binge on it. Varies quite a bit from person to person.

Of course. As he mentioned he struggles with that binge attacks and I tried to give him anecdotal experience from me and people I know, specially for that case. If someone has no issues with that binge attacks and get satisfied with less, they can almost run any type of diet it fits.

 

[lessthanhalf]

I do not think all carbs are equal in terms of effects on appetite or hunger. Despite potatoes often being seen as high glycaemic index, they are also not very calorie dense, even more so if low carb potatoes which have about 50 kcal/ 100 grams, so it is actually pretty hard to eat so many that you end up consuming lots of calories. Half a kilo of potatoes is a lot to eat for only 250 kcal, assuming you do not put oil or fat on them. Whereas 3 slices of bread with a similar number of calories in carbs are a lot easier and quicker to eat and not as filling. You would need to eat about 2 kilos a day of them to not lose weight, which is quite a lot and probably more than most people could easily eat. It would be very easy to eat enough bread to gain weight even if it did not include butter or margarine . And from my experience and there is some experimental confirmation of this, low glycaemic index carbs by definition cause lower glucose peaks, but also cause far less in the way of sudden dips in glucose afterwards, which is presumably the trigger for hunger, or binge eating episodes. I think the low calorific density of potatoes also reduce the degree to which it would spike and dip glucose even if it has a fairly high glycaemic index, just by limiting total calories at a time by volume constraints.

I think that for binge eating and bulmia, GLP's could help in a few different ways. The early satiating effect would presumably reduce the inclination to keep eating after a certain point. The reduction in food noise would reduce general thinking about food as much and lead to less episodes. And the overall reduction in hunger would reduce the basic drive to eat. As well as the alterations in reward circuitry functions, that are thought to reduce many different types of addictive behaviour would help as well. There is no obvious reason they would help with the purging aspects, except by reducing the binging so it is no longer needed.

 

[tubby]

I think the low calorific density of potatoes also reduce the degree to which it would spike and dip glucose even if it has a fairly high glycaemic index, just by limiting total calories at a time by volume constraints.

Not sure what you're getting at here.

While I agree with all of your points and your bread comparison, the surprise I was expressing was that a plain potato diet didn't lead to a "hangry" feeling when compared to an ultra-processed mixed-macro meal (which often can lead to a hangry feeling). Or are you suggesting that a strong blood sugar excursion on its own is insufficient to trigger hangry without an accompanying calorie surplus (either in the meal itself or perhaps averaged around recent meals)?

 

[lessthanhalf]

I do think the number of calories consumed at a time matter, peaks in glucose levels are going to be higher after larger calorie intakes, unless the glycaemic index is zero , so if the total calories in is limited by low calorific density, peaks should be lower.

I do not seem to get the extreme hunger response after eating 100 calories of high glycaemic index foods, even 50% sugar chocolate. I do not want to trigger it so have not really experimented with exactly how many calories are needed.

 

[tubby]

I do think the number of calories consumed at a time matter, peaks in glucose levels are going to be higher after larger calorie intakes, unless the glycaemic index is zero , so if the total calories in is limited by low calorific density, peaks should be lower.

I do not seem to get the extreme hunger response after eating 100 calories of high glycaemic index foods, even 50% sugar chocolate. I do not want to trigger it so have not really experimented with exactly how many calories are needed.

I wonder if we're talking about different phenomena here.

I'm thinking about a strong hunger response that comes 3-5 hours after a meal and mentioning that the potato diet didn't trigger a response like that for me, while processed food sure would have triggered that in the past. I've never heard a calories attribution for that hunger response (just the blood sugar spike/dip response theory that keto people throw around), but I think you're right that calories could possibly be another component to that. The thing that's throwing me off is that you're associating the spike/dip to calories VS glucose/starch. I think it's fairly well established that if the added calories come in the form of fat or protein that will typically serve to reduce the magnitude of the blood sugar spike and dip (although it does stretch out the duration). Many diabetics will specifically add fat or protein to a carb-rich meal, specifically to achieve that muted blood sugar response.

I know a much more established way that calories play into hunger would be related to extended water fasting. There's a fairly established thumb rule there where when you're a ways into a fast (say a day or two) that if you keep your consumption under ~50 calories at a time you can avoid "breaking" the fast and keep it going. Whereas if you get too close or above 50 calories (which I'm sure varies from person to person) you instantly break the fast and almost immediately become ravenously hungry. I wonder if the extreme hunger response you're referring to might be more similar to something like that where the response comes much more quickly after eating something (VS hours later).

 

[Valyra]

No binging = no purging.

As someone who's dealt with eating disorders for most of my life, Reta really solved most of my food related problems and eating doesn't make me feel guilty anymore whatsoever. I couldn't physically binge, no matter how much my mental would want me to.

 

[nkresho]

^ That's what i am hoping to achieve here, thanks for confirming the concept.